Provider Demographics
NPI:1306924535
Name:GEORGETOWN FAMILY PHYSICIANS, PSC
Entity type:Organization
Organization Name:GEORGETOWN FAMILY PHYSICIANS, PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:
Authorized Official - Last Name:WECHMAN
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:502-867-0222
Mailing Address - Street 1:1138 LEXINGTON RD STE 130
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:KY
Mailing Address - Zip Code:40324-9673
Mailing Address - Country:US
Mailing Address - Phone:502-867-0222
Mailing Address - Fax:502-867-0420
Practice Address - Street 1:1138 LEXINGTON RD STE 130
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:KY
Practice Address - Zip Code:40324-9673
Practice Address - Country:US
Practice Address - Phone:502-867-0222
Practice Address - Fax:502-867-0420
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-02
Last Update Date:2011-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY65923146Medicaid
KYH88628Medicare UPIN
KY65923146Medicaid
KY2452Medicare ID - Type Unspecified
KYF79328Medicare UPIN